[Autochthonous amebic liver abscess: microbiological diagnosis by PCR]

Enferm Infecc Microbiol Clin. 2007 Aug-Sep;25(7):493-4

Authors: Gutiérrez-Cisneros MJ, Padín ES, Ormaechea TG, Corripio IF

PMID: 17692221 [PubMed - indexed for MEDLINE]

Melioidosis presenting with isolated splenic abscesses: a case report.

Kaohsiung J Med Sci. 2007 Aug;23(8):417-21

Authors: Lin CY, Chen TC, Lu PL, Lin WR, Chen YH

Splenic abscesses caused by Burkholderia pseudomallei are rarely reported in Taiwan. Here we report a middle-aged man who presented with fever, chills, and general malaise for several days. Abdominal echo revealed isolated splenic abscesses and he received antibiotics treatment according to the initial blood culture result, Serratia marcescens. However, fever did not subside. Then he was referred to our hospital and meropenem was prescribed. Fever subsided 5 days after the beginning of meropenem administration. Repeated fine-needle aspiration of splenic abscesses drained out the pus, which was cultured as B. pseudomallei. He was finally diagnosed as a case of melioidosis based on microbiological evidence. Physicians must take melioidosis into consideration when splenic abscesses are encountered clinically.

PMID: 17666309 [PubMed - indexed for MEDLINE]

Acute appendicitis presenting with abdominal wall and right groin abscess: a case report.

World J Gastroenterol. 2007 Jul 14;13(26):3631-3

Authors: Yildiz M, Karakayali AS, Ozer S, Ozer H, Demir A, Kaptanoglu B

We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.

PMID: 17659716 [PubMed - indexed for MEDLINE]

[Pyogenic liver abscess as presenting manifestation of silent colon adenocarcinoma]

Rev Esp Enferm Dig. 2007 May;99(5):303-5

Authors: Fernández Ruiz M, Guerra Vales JM, Castelbón Fernández FJ, Llenas García J

PMID: 17650946 [PubMed - indexed for MEDLINE]

Gas-forming splenic abscess due to Salmonella enterica serotype Enteritidis in a chronically hemodialyzed patient.

J Microbiol Immunol Infect. 2007 Jun;40(3):276-8

Authors: Hung PH, Chiu YL, Hsueh PR

We describe a diabetic patient who was chronically hemodialyzed due to end-stage renal disease and developed a gas-forming splenic abscess and bacteremia caused by Salmonella enterica serotype Enteritidis. Fever persisted despite urgent splenectomy and intravenous ceftriaxone and metronidazole for 14 days. He recovered completely after intravenous ciprofloxacin/metronidazole treatment for a further 14 days. The isolate was susceptible to ciprofloxacin and ceftriaxone and did not exhibit extended-spectrum beta-lactamase phenotype.

PMID: 17639171 [PubMed - indexed for MEDLINE]

Pyogenic liver abscess caused by accidental ingestion of a wooden toothpick: role of preoperative imaging.

J Gastrointestin Liver Dis. 2007 Jun;16(2):221-2

Authors: Stoica M, Sãftoiu A, Gheonea DI, Dumitrescu D, Surlin V

PMID: 17592574 [PubMed - indexed for MEDLINE]

Isolated liver abscesses in melioidosis.

Indian J Med Microbiol. 2007 Apr;25(2):150-1

Authors: Mukhopadhya A, Balaji V, Jesudason MV, Amte A, Jeyamani R, Kurian G

Melioidosis is a suppurative chronic infection caused by a gramnegative bacterium, Burkholderia pseudomallei. We report two patients who presented with isolated liver abscesses caused by this pathogen. Both patients presented with high-grade fever and abdominal pain. On examination they were toxic and had tender hepatomegaly. Investigations showed leucocytosis and a shift to the left. Early diagnosis of melioidosis was made by culture and growth of Burkholderia pseudomallei from aspirated pus from the abscesses and the patients were treated with ceftazidime and co-trimoxazole. Despite institution of antibiotics both the patients succumbed to their illness. Melioidosis is an emerging infection in the Indian subcontinent and can cause isolated liver abscesses.

PMID: 17582188 [PubMed - indexed for MEDLINE]

Morbidity due to Schistosoma mansoni--Entamoeba histolytica coinfection in hamsters (Mesocricetus auratus).

Rev Soc Bras Med Trop. 2007 Mar-Apr;40(2):170-4

Authors: Dolabella SS, Coelho PM, Borçari IT, Mello NA, Andrade Zde A, Silva EF

Data on Schistosoma mansoni-Entamoeba histolytica coinfection are scarce in the literature. In the present study, hamsters that had been infected for 70 days with Schistosoma mansoni (LE strain) were inoculated via the portal vein with two strains of trophozoites of Entamoeba histolytica: ICB-EGG (highly virulent) and ICB-RPS (non-virulent). The most evident result of coinfection was increased morbidity and mortality, in comparison with either of the infections alone. Histologically, there were no evident signs of interaction between these two infections. The morphological findings of schistosomal granuloma and amoebic abscesses in the liver were similar to those seen in the respective single-infection controls. However, there was severe wasting of the animals with both infections and greater numbers of amoebic lesions in their livers. The results obtained indicated that schistosomiasis aggravates the course of amoebiasis in hamsters.

PMID: 17568883 [PubMed - indexed for MEDLINE]

Septic thrombophlebitis of the superior mesenteric vein and multiple liver abscesses in a patient with Crohn's disease at onset.

BMC Gastroenterol. 2007;7:22

Authors: Aguas M, Bastida G, Nos P, Beltrán B, Grueso JL, Grueso J

BACKGROUND: Portal-mesenteric vein thrombosis, pylephlebitis and liver abscesses are rare complications of inflammatory bowel disease (IBD). The purpose of this case report is to relate an unusual presentation of CD in order to show how conservative treatment could be an appropriate option as a bridge to the surgery, in patients with septic thrombophlebitis and multiple liver abscesses with CD. CASE PRESENTATION: We report a case of a 25-year-old man with Crohn's disease (CD) who developed a superior mesenteric venous thrombosis, multiple liver abscesses and pylephlebitis, diagnosed through abdominal ultrasound and an abdominal computed tomography (CT) scan. The patient was successfully treated with conservative treatment consisting of intravenous antibiotics, subcutaneous anticoagulation and percutaneous catheter drainage of liver abscesses. CONCLUSION: We reported an unnusual case of pylephlebitis in CD. Until now this association has not been reported in adult patients at onset. We hypothesise that the infection developed as a result of mucosal disease and predisposed by corticoid therapy. Adequated management was discussed.

PMID: 17565671 [PubMed - indexed for MEDLINE]

Yersinia enterocolitica infection of mice reveals clonal invasion and abscess formation.

Infect Immun. 2007 Aug;75(8):3802-11

Authors: Oellerich MF, Jacobi CA, Freund S, Niedung K, Bach A, Heesemann J, Trülzsch K

Yersinia enterocolitica is a common cause of food-borne gastrointestinal disease leading to self-limiting diarrhea and mesenteric lymphadenitis. Occasionally, focal abscess formation in the livers and spleens of certain predisposed patients (those with iron overload states such as hemochromatosis) is observed. In the mouse oral infection model, yersiniae produce a similar disease involving the replication of yersiniae in the small intestine, the invasion of Peyer's patches, and dissemination to the liver and spleen. In these tissues and organs, yersiniae are known to replicate predominantly extracellularly and to form microcolonies. By infecting mice orally with a mixture of equal amounts of green- and red-fluorescing yersiniae (yersiniae expressing green or red fluorescent protein), we were able to show for the first time that yersiniae produce exclusively monoclonal microcolonies in Peyer's patches, the liver, and the spleen, indicating that a single bacterium is sufficient to induce microcolony and microabscess formation in vivo. Furthermore, we present evidence for the clonal invasion of Peyer's patches from the small intestine. The finding that only very few yersiniae are required to establish microcolonies in Peyer's patches is due to both Yersinia-specific and host-specific factors. We demonstrate that yersiniae growing in the small intestinal lumen show strongly reduced levels of invasin, the most important factor for the early invasion of Peyer's patches. Furthermore, we show that the host severely restricts sequential microcolony formation in previously infected Peyer's patches.

PMID: 17562774 [PubMed - indexed for MEDLINE]

Non-resolving liver abscess with Echinococcus cross-reactivity in a non-endemic region.

Indian J Gastroenterol. 2007 Mar-Apr;26(2):92-3

Authors: Das K, Sakuja P, Aggarwal A, Puri AS, Tatke M

A 40-year-old woman presented with high fever with chills and rigors. Imaging studies revealed multiple liver abscesses with hepatosplenomegaly and gall-stones. Ultrasound-guided aspirate revealed pus that was negative on Gram and acid-fast staining and for amebic trophozoites. ELISA for echinococcus was strongly positive, but she did not respond to albendazole therapy. At surgery, Fasciola hepatica was detected and she responded well to bithinol postoperative.

PMID: 17558077 [PubMed - indexed for MEDLINE]

Diagnosis of bacterial hepatic abscess by CT.

Hepatobiliary Pancreat Dis Int. 2007 Jun;6(3):271-5

Authors: Wang CL, Guo XJ, Qiu SB, Lei Y, Yuan ZD, Dong HB, Liu HA

BACKGROUND: Bacterial hepatic abscess usually is acute and progressive, often resulting in sepsis, impairment of liver function and disseminated intravascular coagulation. The mortality rate was as high as 80% in the past. For the purpose of early diagnosis and differential diagnosis of this disease, we probed the imaging manifestations and their characteristics in bacterial hepatic abscesses by CT scan. METHODS: Twenty-four lesions from 21 patients with bacterial hepatic abscesses that were confirmed by clinical features, puncture and culture were reviewed for CT manifestations. Fourteen patients were male and 7 were female, with an average age of 56.2 years. All lesions underwent CT plain scan and three-phase enhanced scan and 15 patients underwent delayed-phase imaging. Three senior radiologists read the films in accordance with a standard. RESULTS: Among 24 lesions, 18 (75%) were situated in the right liver with diameters of 1.4-9.3 cm (average 4.5 cm). Nineteen (79.2%) lesions were round or sub-round in shape, and 22 (91.7%) had smooth, uninterrupted and sharp edges. All lesions showed low attenuation of less than 20 Hu. Twenty-two enhanced lesions (91.7%) had rim-shaped enhancement in the abscess wall, and 13 (54.2%) showed single or double-ring signs. Eighteen (75%) displayed honeycomb-like, grid-like or strip-like enhancement. Eighteen (75%) were regionally enhanced in the surroundings or upper or lower layers. Only 2 (8.3%) displayed a gas-liquid surface sign. CONCLUSIONS: The CT findings of bacterial hepatic abscess are usually typical, and the diagnosis of the abscess is not difficult. To precisely diagnose atypical cases, it is necessary to combine CT with clinical observations and follow-up.

PMID: 17548250 [PubMed - indexed for MEDLINE]

Detection of excretory Entamoeba histolytica DNA in the urine, and detection of E. histolytica DNA and lectin antigen in the liver abscess pus for the diagnosis of amoebic liver abscess.

BMC Microbiol. 2007;7:41

Authors: Parija SC, Khairnar K

BACKGROUND: Amoebic liver abscess (ALA) and pyogenic liver abscesses (PLA) appear identical by ultrasound and other imaging techniques. Collection of blood or liver abscess pus for diagnosis of liver abscesses is an invasive procedure, and the procedure requires technical expertise and disposable syringes. Collection of urine is a noninvasive procedure. Therefore, there has been much interest shown towards the use of urine as an alternative clinical specimen for the diagnosis of some parasitic infections. Here, we report for the first time the detection of E. histolytica DNA excreted in the urine for diagnosis of the cases of ALA. RESULTS: E. histolytica DNA was detected in liver abscess pus specimen of 80.4% of ALA patients by a nested multiplex polymerase chain reaction (PCR) targeting 16S-like r RNA gene. The nested PCR detected E. histolytica DNA in all 37 (100%) liver abscess pus specimens collected prior to metronidazole treatment, but were detected in only 53 of 75 (70.6%) pus specimens collected after therapy with metronidazole. Similarly, the PCR detected E. histolytica DNA in 21 of 53 (39.6%) urine specimens of ALA patients. The test detected E. histolytica DNA in only 4 of 23 (17.4%) urine specimens collected prior to metronidazole treatment, but were detected in 17 of 30 (56.7%) urine specimens collected after treatment with metronidazole. The enzyme-linked immunosorbent assay (ELISA) for the detection of lectin E. histolytica antigen in the liver abscess pus showed a sensitivity of 50% and the indirect haemagglutination (IHA) test for detection of amoebic antibodies in the serum showed a sensitivity of 76.8% for the diagnosis of the ALA. CONCLUSION: The present study for the first time shows that the kidney barrier in ALA patients is permeable to E. histolytica DNA molecule resulting in excretion of E. histolytica DNA in urine which can be detected by PCR. The study also shows that the PCR for detection of E. histolytica DNA in urine of patients with ALA can also be used as a prognostic marker to assess the course of the diseases following therapy by metronidazole. The detection of E. histolytica DNA in urine specimen of ALA patients provides a new approach for the diagnosis of ALA.

PMID: 17511859 [PubMed - indexed for MEDLINE]

Diverticular abscess presenting as a strangulated inguinal hernia: case report and review of the literature.

Ulster Med J. 2007 May;76(2):107-8

Authors: Andrabi SI, Pitale A, El-Hakeem AA

Potentially life threatening diseases can mimic a groin hernia. We present an unusual case of diverticulitis with perforation and a resulting abscess presenting as a strangulated inguinal hernia. The features demonstrated were not due to strangulation of the contents of the hernia but rather pus tracking into the hernia sac from the peritoneal cavity. The patient underwent sigmoid resection and drainage of retroperitoneal and pericolonic abscesses. Radiological and laboratory studies augment in reaching a diagnosis. The differential diagnosis of inguinal swellings is discussed.

PMID: 17476826 [PubMed - indexed for MEDLINE]

Retained percutaneous tube--a misery of illiteracy.

Asian J Surg. 2007 Apr;30(2):141-2

Authors: Godara R, Dalal S, Garg P, Nityasha N, Jain A, Mala R

Percutaneous catheter drainage of liver abscesses is an established technique. Intracavitatory knotting of the tube is a rare and potentially preventable complication that can involve significant morbidity. However, because of the rarity of this complication, there remains a persistent lack of awareness in the clinical community. The risk of tube knotting can be reduced with proper technique and correct choice of tubes.

PMID: 17475586 [PubMed - indexed for MEDLINE]

Liver abscess caused by tuberculosis and melioidosis.

Asian J Surg. 2007 Apr;30(2):138-40

Authors: Azali HY, Norly S, Wong LM, Tan KS, Safian NM

We report an unusual co-existence of Burkholderia pseudomallei and acid fast bacilli in a young Malay gentleman with liver abscess. He was treated with antibiotics and surgical drainage. This phenomenon has not been reported in previous literature and the dilemma of its management is discussed.

PMID: 17475585 [PubMed - indexed for MEDLINE]

Hepatic abscess induced by foreign body: case report and literature review.

World J Gastroenterol. 2007 Mar 7;13(9):1466-70

Authors: Santos SA, Alberto SC, Cruz E, Pires E, Figueira T, Coimbra E, Estevez J, Oliveira M, Novais L, Deus JR

Hepatic abscess due to perforation of the gastrointestinal tract caused by ingested foreign bodies is uncommon. Pre-operative diagnosis is difficult as patients are often unaware of the foreign body ingestion and symptoms and imagiology are usually non-specific. The authors report a case of 62-year-old woman who was admitted with fever and abdominal pain. Further investigation revealed hepatic abscess, without resolution despite antibiotic therapy. A liver abscess resulting from perforation and intra-hepatic migration of a bone coming from the pilorum was diagnosed by surgery. The literature concerning foreign body-induced perforation of the gastrointestinal tract complicated by liver abscess is reviewed.

PMID: 17457985 [PubMed - indexed for MEDLINE]

Endoscopic transcystic stent placement for an intrahepatic abscess due to gallbladder perforation.

World J Gastroenterol. 2007 Mar 7;13(9):1458-9

Authors: Kang MS, Park do H, Kwon KD, Park JH, Lee SH, Kim HS, Park SH, Kim SJ

Perforation of the gallbladder with cholecystohepatic communication is a rare cause of liver abscess. Because it is a rare entity, the treatment modality has not been fully established. We report for the first time a patient with an intrahepatic abscess due to gallbladder perforation successfully treated by endoscopic stent placement into the gallbladder who had a poor response to continuous percutaneous drainage.

PMID: 17457983 [PubMed - indexed for MEDLINE]

Hepatic abscess in a preterm neonate.

Indian Pediatr. 2007 Mar;44(3):226-8

Authors: Sharma S, Mohta A, Sharma P

We present a preterm (32 weeks; weight 1300 g) neonate, with solitary hepatic abscess. The causative organism was Klebsiella. The child presented with septicemia, hepatomegaly and abdominal lump. Radiological investigations were inconclusive. Surgical drainage and prolonged antibiotic treatment led to resolution of the hepatic abscess.

PMID: 17413202 [PubMed - indexed for MEDLINE]

[Emphysematous pyelonephritis with perirenal abscess cured with conservative medical treatment]

Nefrologia. 2007;27(1):93-5

Authors: Peces R, Fernández EJ, González E, Peces C

PMID: 17402891 [PubMed - indexed for MEDLINE]

Pyogenic liver abscess caused by Klebsiella pneumoniae: analysis of the clinical characteristics and outcomes of 84 patients.

Chin Med J (Engl). 2007 Jan 20;120(2):136-9

Authors: Chan KS, Yu WL, Tsai CL, Cheng KC, Hou CC, Lee MC, Tan CK

BACKGROUND: The increased incidence of pyogenic liver abscess caused by Klebsiella pneumoniae (K.pneumoniae) was reported in the recent literature. This study was conducted retrospectively to investigate the clinical characteristics and outcomes of these patients. METHODS: Microbiological and medical databases of a medical center were searched from January 2000 to June 2003. Eighty-four patients with liver abscess caused by K.pneumoniae were analyzed. RESULTS: In the 84 patients, 52 men and 32 women aged (58.2 +/- 13.3) years on average, 64.4% had concomitant diabetes mellitus and 23.8% had biliary disease. The most common clinical symptoms were fever (98.8%), chills (69.0%) and abdominal pain (58.3%). 85.7% of the 84 patients received catheter drainage for the abscess. The length of hospital stay was (17.4 +/- 8.7) days. The mortality rate was 7.1%. Older age and presence of biliary disease were associated with mortality. CONCLUSIONS: The low mortality of our patients was probably related to the high proportion of patients who received catheter drainage. Older age and presence of biliary disease were associated with the mortality.

PMID: 17335656 [PubMed - indexed for MEDLINE]

The 29-kilodalton thiol-dependent peroxidase of Entamoeba histolytica is a factor involved in pathogenesis and survival of the parasite during oxidative stress.

Eukaryot Cell. 2007 Apr;6(4):664-73

Authors: Sen A, Chatterjee NS, Akbar MA, Nandi N, Das P

The 29-kDa surface antigen (thiol-dependent peroxidase; Eh29) of Entamoeba histolytica exhibits peroxidative and protective antioxidant activities. During tissue invasion, the trophozoites are exposed to oxidative stress and need to deal with highly toxic reactive oxygen species (ROS). In this investigation, attempts have been made to understand the role of the 29-kDa peroxidase gene in parasite survival and pathogenesis. Inhibition of eh29 gene expression by antisense RNA technology has shown approximately 55% inhibition in eh29 expression, maximum ROS accumulation, and significantly lower viability in 29-kDa downregulated trophozoites during oxidative stress. The cytopathic and cytotoxic activities were also found to decrease effectively in the 29-kDa downregulated trophozoites. Size of liver abscesses was substantially lower in hamsters inoculated with 29-kDa downregulated trophozoites compared to the normal HM1:IMSS. These findings clearly suggest that the 29-kDa protein of E. histolytica has a role in both survival of trophozoites in the presence of ROS and pathogenesis of amoebiasis.

PMID: 17307964 [PubMed - indexed for MEDLINE]

Hepatic parasitic abscess caused by clonorchiasis: unusual CT findings of clonorchiasis.

Korean J Radiol. 2007 Jan-Feb;8(1):70-3

Authors: Jang YJ, Byun JH, Yoon SE, Yu E

Clonorchiasis is caused by a chronic infestation of liver flukes, Clonorchis sinensis, and these reside mainly in the medium- and small-sized intrahepatic bile ducts. Therefore, diffuse, uniform, minimal or mild dilatation of these bile ducts, particularly in the periphery, without dilatation of the extrahepatic bile duct is the typical finding on several imaging modalities. We report here on the CT findings of an unusual case of hepatic parasitic abscess that was caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts.

PMID: 17277566 [PubMed - indexed for MEDLINE]

Ruptured tubo-ovarian abscess in a postmenopausal woman presenting with septic shock: a case report and literature review.

Taiwan J Obstet Gynecol. 2006 Mar;45(1):89-91

Authors: Chia CC, Huang SC

OBJECTIVE: To report a case of a ruptured tubo-ovarian abscess which induced septic shock in a postmenopausal woman. CASE REPORT: A 53-year-old postmenopausal woman was transferred to our emergency department for drowsiness, hypotension, and lower abdominal discomfort. Transabdominal sonography and computed tomography showed a large pelvic tumor over the left adnexa with some ascites. The uterus and other adnexa were unremarkable. Laboratory data, including blood count and electrolytes, showed leukocytosis and azotemia. Under suspicion of a ruptured adnexal tumor, laparotomy was performed and showed a large ruptured tubo-ovarian tumor arising from the left adnexa with intra-abdominal pus formation. Subtotal hysterectomy and bilateral salpingo-oophorectomy led to massive bleeding during manipulation of the left adnexa because of the necrotic change in the left infundibulopelvic vessels. Deep vein thrombosis and wound disruption occurred after the operation, but, fortunately, she recovered 1 month later. CONCLUSION: Tubo-ovarian abscesses in postmenopausal women are uncommon but should be kept in mind with a pelvic tumor accompanied by septic shock, as this may cause a terrible outcome and other sequelae.

PMID: 17272220 [PubMed - indexed for MEDLINE]

Infectious complications following laparoscopic appendectomy.

Can J Surg. 2006 Dec;49(6):397-400

Authors: Gupta R, Sample C, Bamehriz F, Birch DW

INTRODUCTION: A meta-analysis of the literature suggests there is an increased rate of intra-abdominal abscess after laparoscopic appendectomy (LA) compared with open appendectomy (OA). METHODS: To analyze the infectious complications of LA at one tertiary care centre, we completed a retrospective chart review for all patients undergoing LA for acute appendicitis from 1995 to 2002. RESULTS: We used established exclusion criteria to identify 175 patients with a mean age of 37.6 (standard deviation [SD] 14.5) years (95 male, 80 female). The mean operating time was 61.9 (SD 22.5) minutes. Excluding conversions to OA (14/175, 8%), operating time was 59.9 (SD 20.5) minutes. On surgical assessment, 143 patients had acute nonperforated appendicitis (17 perforated, 15 gangrenous). However, on histopathology assessment, 13 cases of normal appendix were identified (13/175, 7.4%). The overall median length of stay was 2.0 days. Three patients had significant postoperative infectious complications, including 1 wound infection and 2 cases of intra-abdominal abscesses. All abscesses were managed successfully with percutaneous drainage. An analysis of perioperative factors that might have contributed to the infectious complications revealed that each case of postoperative intra-abdominal abscess occurred in patients with gangrenous appendicitis and when extensive irrigation was used during LA. CONCLUSIONS: An institutional review demonstrates outcomes comparable with the Cochrane systematic review of the published literature. Technical issues that may impact on intra-abdominal abscess formation after LA include aggressive manipulation of the infected appendix and increased use of irrigation fluid, possibly producing greater contamination of the peritoneal cavity.

PMID: 17234067 [PubMed - indexed for MEDLINE]